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Individuals with Disabilities and Employment Survey
Posted: 19 Mar 2014 11:21 AM PDT
Please consider taking this survey if you are an individual with a disability and meet the criteria below.
Thanks,
McNair
Individuals with Disabilities and Employment Survey
The purpose of this survey is to identify the influences and obstacles that have enabled individuals with disabilities to acquire and maintain part-time or full-time employment.
To participate, you must have a disability AND have been working part-time or full-time for at least 1 year. Your feedback is important, entirely confidential, and completely anonymous.
Employment survey
https://docs.google.com/forms/d/1Hz0RXsUAaVpy9Kl-o5OzqRCtPNlblgiumvHCwx8iJag/viewform
Individuals with Disabilities and Employment Survey
The purpose of this survey is to identify the influences and obstacles that have enabled individuals with disabilities to acquire and maintain part-time or full-time employment.
To participate, you must have a disability AND have been working part-time or full-time for at least 1 year. Your feedback is important, entirely confidential, and completely anonymous.
This survey should take 15 minutes to complete. All questions are marked with an asterisk (*) and require an answer. In order to progress through the survey, please use the following navigation buttons:
Click Continue to move to the next page.
Click Back to return to the previous page.
Click Submit to complete the survey.
After clicking Continue at the bottom of each page, if the survey does not advance, review each question to ensure all have been answered. Remember to click Submit on the last page.
Thank you for your time and assistance in completing this survey.
* Required
Disability-Related Questions
Age at onset of disability? *
Are you familiar with the Americans with Disabilities Act? *
How did you learn/hear about the Americans with Disabilities Act? *
A brief explanation is appreciated. Use n/a if it does not apply.
Did the Americans with Disabilities Act enable you to gain employment? *
Explain. *
A brief explanation is appreciated. Use n/a if it does not apply.
Type of Disability *
Check all that apply
Attention Deficit Disorder (ADD)/Attention Deficit Hyperactivity Disorder (ADHD)
Blind or Low Vision
Brain Injury
Deaf/Hard of Hearing
Developmental Disabilities
Medical Disabilities
Physical Disabilities
Psychiatric Disabilities
Other:
General Demographics
Gender *
Race/Ethnicity *
Current age *
Current gross income *
Marital Status *
Number of children/dependants *
Zip Code
Optional
Education
Highest Level of Education Completed *
Did you receive any vocational education or rehabilitation services as a result of your disability? *
Were you required to participate in an internship as a result of your vocational education or rehabilitation services? *
Was your intership... *
How would you rate your overall internship experience? *
Explain *
A brief explanation is appreciated. Use n/a if it does not apply.
During your internship, were any accommodations made for you because of your disability? *
Explain. *
A brief explanation is appreciated. Use n/a if it does not apply.
Did the accommodations you received help you to successfully complete the internship? *
Explain *
A brief explanation is appreciated. Use n/a if it does not apply.
In your opinion, is there value in an unpaid internship? *
Explain. *
A brief explanation is appreciated. Use n/a if it does not apply.
Are you aware of a federal court ruling issued on the illegality of unpaid internships? *
Benefits
Which of the following government benefits are you currently receiving? *
Check all that apply
SSI (Supplemental Security Income)
SSDI (Social Security Disability Insurance)
Medicaid
Medicare
Veterans' Benefits
Food Stamps
Social Services
None
Other:
Did you lose any government benefits as a consequence of your employment? *
A brief explanation is appreciated. Use n/a if it does not apply.
Did receiving benefits deter or delay you from employment? *
A brief explanation is appreciated. Use n/a if it does not apply.
Employment
Gross income BEFORE employment *
Years employed since my disability *
Hourly wage *
Employment status *
Number of hours worked per week *
Are you satisfied with your employment status? *
Explain. *
A brief explanation is appreciated. Use n/a if it does not apply.
Have any of the following enabled you to begin or continue working? *
Check all that apply
Training to gain or improve skills
Access to equipment, device, interpreter or personal assistant which you need in order to do your work, talk to other workers, or get around at work
Option to telework or telecommute
Change in benefits from vocational rehabilitation services or a local non-profit agency
None of these
Other:
Where are you employed? *
Check all that apply
Nonprofit
Government
Small Business
Education
Corporate
Retail
Manufacturing
Healthcare
Domestic
Laborer
Other:
What type of work do you do? *
From your experience, are government programs attempting to help individuals with disabilities to gain employment? *
How long have you been with your current employer? *
(Round number to the closest year)
Explain. *
A brief explanation is appreciated. Use n/a if it does not apply.
How did you acquire your first job after your disability? *
What are two changes you would like to see that would facilitate employment for persons with disabilities? *
A brief explanation is appreciated. Use n/a if it does not apply.
Do you know about Social Security's Ticket to Work Program? *
Have you ever/are you currently participating in Social Security's Ticket to Work Program? *
Social Security's Ticket to Work Program is a free and voluntary program available to people ages 18 through 64 who are blind or have a disability and who receive Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits.
Please explain how you have benefited from your participation in Social Security's Ticket to Work Program? *
A brief explanation is appreciated. Use n/a if it does not apply.
Have you ever requested any adjustment to a job or a workspace defined as a "reasonable accommodation" by the Americans with Disabilities Act? *
How has your employer assisted you with your "reasonable accommodation"? *
Explain. A brief explanation is appreciated. Use n/a if it does not apply.
Has your disability limited your employment opportunities? *
Explain. *
A brief explanation is appreciated. Use n/a if it does not apply.
Were your reasons for returning to work *
Check all that apply
financial
personal enrichment
need-based
provide structure
Other:
Please describe any barriers, obstacles, or challenges on your path to employment and/or maintaining employment. *
Recommendations? Concerns? *
A brief explanation is appreciated. Use n/a if it does not apply.
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